Eight percent of the American population is diabetic, and that rate is expected to double in the next 10 years because more and more young people will develop the disease as a result of epidemic obesity.
At a recent three-day medical meeting in Los Angeles on diabetic feet, doctors reported that the rates of foot amputations as a complication of diabetes have soared over the last 15 years. Every year, 100,000 diabetics are getting their feet cut off; these are people who are generally ignored in our society because they are old, overweight, and often a racial minority;
The statistics make my blood boil because we have to stop cutting off feet as a model of healthcare delivery. The current interventional model that treats diseases when people get sick is inefficient, costly and ultimately ineffective. The future of medicine is about moving from intervention to prediction and prevention.
Here is a perfect example of what a new model of healthcare could do. Treating diabetes-related surgical complications in this country costs $40 billion a year. That cost is in addition to the $116 billion it costs just to the treat uncomplicated diabetes. For less money, we could invest in mobile vans, staffed by skilled professionals, who would set up diabetic clinics in high-risk neighborhoods. Every week, at the same predictable time, in parking lots and senior centers, patients could come in to be checked by clinicians who would look at their skin before it broke down and got infected. The dependable presence would allow patients to develop relationships with clinicians, which is a critical element in getting patients to change their unhealthful behaviors. Professionals who are liked and trusted can inspire patients to become the principal agents in their own healing. If we paid some loving attention to these isolated patients, they would eat better, exercise more, and stress less.
If we spent only half of what we currently do on amputations, the savings would buy mobile clinics in every city in America, with money left over to support local gymnasium programs to encourage weight loss and fitness. That, in turn, would help reduce the number of symptomatic diabetics which would save additional billions. That money could be used for other mobile clinics that address maternal and child health, and the treatment of the chronically mentally ill who now walk aimlessly on downtown streets.
This is transformational, paradigm-shifting health-care reform which will move us from an interventional, illness-based model to one that will allow patients to walk away from amputation through healthful participation.